Cancer Research

This report considers the biological and behavioral mechanisms that may underlie the pathogenicity of tobacco smoke. Many Surgeon General's reports have considered research findings on mechanisms in assessing the biological plausibility of associations observed in epidemiologic studies. Mechanisms of disease are important because they may provide plausibility, which is one of the guideline criteria for assessing evidence on causation. This report specifically reviews the evidence on the potential mechanisms by which smoking causes diseases and considers whether a mechanism is likely to be operative in the production of human disease by tobacco smoke. This evidence is relevant to understanding how smoking causes disease, to identifying those who may be particularly susceptible, and to assessing the potential risks of tobacco products.

Some people suffer from chronic, debilitating disorders for which no conventional treatment brings relief. Can marijuana ease their symptoms? Would it be breaking the law to turn to marijuana as a medication? There are few sources of objective, scientifically sound advice for people in this situation. Most books about marijuana and medicine attempt to promote the views of advocates or opponents. To fill the gap between these extremes, authors Alison Mack and Janet Joy have extracted critical findings from a recent Institute of Medicine study on this important issue, interpreting them for a general audience. Marijuana As Medicine? provides patientsâ€"as well as the people who care for themâ€"with a foundation for making decisions about their own health care. This empowering volume examines several key points, including: Whether marijuana can relieve a variety of symptoms, including pain, muscle spasticity, nausea, and appetite loss. The dangers of smoking marijuana, as well as the effects of its active chemical components on the immune system and on psychological health. The potential use of marijuana-based medications on symptoms of AIDS, cancer, multiple sclerosis, and several other specific disorders, in comparison with existing treatments. Marijuana As Medicine? introduces readers to the active compounds in marijuana. These include the principal ingredient in Marinol, a legal medication. The authors also discuss the prospects for developing other drugs derived from marijuana's active ingredients. In addition to providing an up-to-date review of the science behind the medical marijuana debate, Mack and Joy also answer common questions about the legal status of marijuana, explaining the conflict between state and federal law regarding its medical use. Intended primarily as an aid to patients and caregivers, this book objectively presents critical information so that it can be used to make responsible health care decisions. Marijuana As Medicine? will also be a valuable resource for policymakers, health care providers, patient counselors, medical faculty and studentsâ€"in short, anyone who wants to learn more about this important issue.

Malignant growth of cells is often characterized by disorganization of tissue structure, abnormal blood vessel development, and insuffi cient vascular supply. As a consequence, the cancer cells grow in a three-dimensional pattern in atypical microenvironments which include physical, chemical, and nutritional stresses. Necrosis often develops some distance away from the blood vessels. In association with an inherent instability in malignant cell populations, and also because of the changing micromilieu, significant cellular heteroge neity emerges with regard to various phenotypic characteristics. Both biological behavior and responses to therapeutic agents can be affected. A variety of in vitro and in vivo experimental models exist for research on properties of cancer cells during growth. The multicell spheroid model was developed as a system of intermediate complexity in which three dimensional growth of cells enhances cell-cell interactions and creates micro environments that simulate the conditions in intervascular microregions of tumors or microme tastatic foci. Spheroids may change their cellular characteristics with changing environments during growth. These can be studied under controlled conditions in vitro. Interest in details of experimental methods for this model system stimulated the organization of the First International Conference in Rochester, NY in 1980, the Proceedings of which were summarized in Cancer Research in 1981. Since then there has been a rapid increase in the use of this model system, and increased research on the significance of cell-cell and cell-microenvironment interactions in biology in general.

An ideal health care system relies on efficiently generating timely, accurate evidence to deliver on its promise of diminishing the divide between clinical practice and research. There are growing indications, however, that the current health care system and the clinical research that guides medical decisions in the United States falls far short of this vision. The process of generating medical evidence through clinical trials in the United States is expensive and lengthy, includes a number of regulatory hurdles, and is based on a limited infrastructure. The link between clinical research and medical progress is also frequently misunderstood or unsupported by both patients and providers. The focus of clinical research changes as diseases emerge and new treatments create cures for old conditions. As diseases evolve, the ultimate goal remains to speed new and improved medical treatments to patients throughout the world. To keep pace with rapidly changing health care demands, clinical research resources need to be organized and on hand to address the numerous health care questions that continually emerge. Improving the overall capacity of the clinical research enterprise will depend on ensuring that there is an adequate infrastructure in place to support the investigators who conduct research, the patients with real diseases who volunteer to participate in experimental research, and the institutions that organize and carry out the trials. To address these issues and better understand the current state of clinical research in the United States, the Institute of Medicine's (IOM) Forum on Drug Discovery, Development, and Translation held a 2-day workshop entitled Transforming Clinical Research in the United States. The workshop, summarized in this volume, laid the foundation for a broader initiative of the Forum addressing different aspects of clinical research. Future Forum plans include further examining regulatory, administrative, and structural barriers to the effective conduct of clinical research; developing a vision for a stable, continuously funded clinical research infrastructure in the United States; and considering strategies and collaborative activities to facilitate more robust public engagement in the clinical research enterprise.

This book describes the molecular mechanisms of lung cancer development and progression that determine therapeutic interventions in the era of genomics, when the rapid evolution in lung cancer diagnosis and treatment necessitates critical review of new results to integrate advances into practice. The text opens with background and emerging information regarding the molecular biology of lung cancer pathogenesis. Updated results regarding lung cancer prevention and screening are discussed, followed by chapters on diagnostic techniques and pathological evaluation. This leads on to a detailed presentation of treatment modalities, from surgery and radiation therapy to standard chemotherapy and targeted agents. The coverage includes resistance to therapy and the emergence of immunotherapy for lung cancer; in addition, the current evidence in respect of small cell lung cancer is summarized. The book presents insights from experts across disciplines to emphasize the importance of collaborative care. Advances in our understanding of issues in geriatric oncology and palliative care complete the comprehensive discussion of lung cancer.